Healthcare Provider Details

I. General information

NPI: 1760303192
Provider Name (Legal Business Name): JASMINE N/A PAKTAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 E FOOTHILL BLVD
AZUSA CA
91702-2515
US

IV. Provider business mailing address

6281 PRISCILLA DR
HUNTINGTON BEACH CA
92647-2846
US

V. Phone/Fax

Practice location:
  • Phone: 714-363-2665
  • Fax:
Mailing address:
  • Phone: 714-363-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT28781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: